MSF crisis alert: The new face of an old disease

Executive summary: Global drug-resistant TB crisis demands mass mobilisation and new treatments

Tuberculosis is one of the gravest public health threats facing the world today, and is all the more serious as drug resistance takes a grip.

Tuberculosis (TB) is a curable disease, but an inadequate global response has allowed the growing epidemic of drug-resistant tuberculosis (DR-TB) to take hold. Drug-resistant forms of TB are much harder to cure: standard TB drugs don’t work, and doctors must turn to long, arduous, complex and expensive treatment regimens that only cure half the patients at best.

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DR-TB originally developed because of improper use of anti-TB medicines, and now these deadlier DR-TB strains are spreading from person to person, even to people who’ve never had TB before. Today there are nearly half a million new cases of multidrug-resistant TB a year, with drug-resistant forms of TB reported in virtually all countries worldwide.

Tuberculosis and drug-resistant forms of TB One-third of the world’s population, around two billion people, is infected with the TB bacterium but does not have active TB disease. This is often referred to as dormant or ‘latent’ TB. About 10% of these people develop the active form of the disease during their lifetime and become sick and potentially infectious. Every year, around eight
million people worldwide fall ill from TB, and 1.3 million people die from the disease.1 TB is airborne and contagious, and now new forms which cannot be cured with standard TB treatments are appearing at an alarming rate. The most widely reported strain is multidrug-resistant TB (MDR-TB), which is resistant to the two most powerful anti-TB drugs. Extensively drugresistantTB (XDR-TB) is even harder to treat.

As new tools for diagnosing MDR-TB rapidly become more widely used, more and more people are being diagnosed, but only one in five people who need it can obtain treatment. And no matter where you live in the world, the only treatments available entail

people swallowing well over 10,000 pills and having eight months of painful injections, with potentially horrific and long-lasting side effects. As the numbers mount, developing countries face insurmountable drug costs, exacerbated by the long periods of care and management of side effects. It is perhaps little wonder that, with the high costs and the inadequate treatment, DR-TB care is so
minimally available worldwide. Meanwhile the critical gap between the numbers of suspected DR-TB cases and those successfully treated leaves the airborne killer to spread indiscriminately. “The DR-TB crisis is everybody’s problem and demands an immediate international response. Each year we are diagnosing more patients with DR-TB, but the current treatments aren’t good enough to
make a dent in the epidemic. It doesn’t matter where you live; until new short and more effective treatment combinations are found, the odds of surviving this disease today are dismal.” Sidney Wong, MSF medical director.

New short, safe and effective treatment combinations are key to unlocking the global DR-TB crisis, and today there is reason for hope. The first new TB drugs in 50 years, along with developments in diagnostic tests and new approaches to care, have real potential to radically improve patient outcomes. Yet no single drug can combat this disease, and merely adding new drugs to today’s regimens won’t solve the problems of complexity, toxicity, length and cost.

Unfortunately, patients remain years from getting the cures they desperately need unless governments, pharmaceutical companies and researchers quickly mobilise the necessary resources and political will. Collaborative research is urgently needed to find much improved treatment combinations that are fit for purpose, reasonably priced and able to be rolled out rapidly in resource-limited settings. In the meantime, increased efforts must be made to diagnose and treat more people with DR-TB today to save lives and slow the spread of this virulent disease.